Public Health Division, ICF International, New York, New York.
Duke University School of Medicine, Durham, North Carolina.
JAMA Psychiatry. 2015 Nov;72(11):1143-9. doi: 10.1001/jamapsychiatry.2015.1933.
Youth suicide prevention is a major public health priority. Studies documenting the effectiveness of community-based suicide prevention programs in reducing the number of nonlethal suicide attempts have been sparse.
To determine whether a reduction in suicide attempts among youths occurs following the implementation of the Garrett Lee Smith Memorial Suicide Prevention Program (hereafter referred to as the GLS program), consistent with the reduction in mortality documented previously.
DESIGN, SETTING, AND PARTICIPANTS: We conducted an observational study of community-based suicide prevention programs for youths across 46 states and 12 tribal communities. The study compared 466 counties implementing the GLS program between 2006 and 2009 with 1161 counties that shared key preintervention characteristics but were not exposed to the GLS program. The unweighted rounded numbers of respondents used in this analysis were 84 000 in the control group and 57 000 in the intervention group. We used propensity score-based techniques to increase comparability (on background characteristics) between counties that implemented the GLS program and counties that did not. We combined information on program activities collected by the GLS national evaluation with information on county characteristics from several secondary sources. The data analysis was performed between April and August 2014. P < .05 was considered statistically significant.
Comprehensive, multifaceted suicide prevention programs, including gatekeeper training, education and mental health awareness programs, screening activities, improved community partnerships and linkages to service, programs for suicide survivors, and crisis hotlines.
Suicide attempt rates for each county following implementation of the GLS program for youths 16 to 23 years of age at the time the program activities were implemented. We obtained this information from the National Survey on Drug Use and Health administered to a large national probabilistic sample between 2008 and 2011.
Counties implementing GLS program activities had significantly lower suicide attempt rates among youths 16 to 23 years of age in the year following implementation of the GLS program than did similar counties that did not implement GLS program activities (4.9 fewer attempts per 1000 youths [95% CI, 1.8-8.0 fewer attempts per 1000 youths]; P = .003). More than 79 000 suicide attempts may have been averted during the period studied following implementation of the GLS program. There was no significant difference in suicide attempt rates among individuals older than 23 years during that same period. There was no evidence of longer-term differences in suicide attempt rates.
Comprehensive GLS program activities were associated with a reduction in suicide attempt rates. Sustained suicide prevention programming efforts may be needed to maintain the reduction in suicide attempt rates.
青少年自杀预防是一项主要的公共卫生重点。有研究记录了基于社区的自杀预防计划在减少非致命性自杀企图数量方面的有效性，但这些研究仍然很少。
确定在实施加勒特·李·史密斯纪念自杀预防计划（以下简称 GLS 计划）后，青少年的自杀企图是否会减少，这与之前记录的死亡率降低相一致。
设计、地点和参与者：我们对 46 个州和 12 个部落社区的基于社区的青少年自杀预防计划进行了观察性研究。该研究比较了 2006 年至 2009 年间实施 GLS 计划的 466 个县与 1161 个具有关键干预前特征但未接触 GLS 计划的县。本分析中使用的未加权整数应答者数量分别为对照组的 84000 人和干预组的 57000 人。我们使用基于倾向评分的技术来增加实施 GLS 计划的县和未实施 GLS 计划的县之间的可比性（在背景特征方面）。我们将 GLS 国家评估收集的有关计划活动的信息与来自多个二级来源的县特征信息相结合。数据分析于 2014 年 4 月至 8 月进行。p 值<.05 被认为具有统计学意义。
全面、多方面的自杀预防计划，包括守门员培训、教育和心理健康意识计划、筛查活动、改善社区伙伴关系和与服务的联系、自杀幸存者计划和危机热线。
实施 GLS 计划后，16 至 23 岁青少年的自杀企图率，实施 GLS 计划活动时该年龄段的青少年。我们从 2008 年至 2011 年期间对一个大型全国概率样本进行的国家药物使用和健康调查中获得了这一信息。
实施 GLS 计划活动的县，在实施 GLS 计划后的一年中，16 至 23 岁青少年的自杀企图率显著低于未实施 GLS 计划活动的类似县（每 1000 名青少年减少 4.9 次企图[95%CI，每 1000 名青少年减少 1.8-8.0 次企图]；p=0.003）。在实施 GLS 计划后的研究期间，可能避免了超过 79000 次自杀企图。同期，23 岁以上人群的自杀企图率无显著差异。没有证据表明自杀企图率存在长期差异。
全面的 GLS 计划活动与自杀企图率的降低有关。可能需要持续进行自杀预防计划工作，以维持自杀企图率的降低。
